Organization
OUTREACH RECOVERY II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISIAH COLES ATC (COO)
(561) 502-3978
Entity
Organization
Contact information
Practice address
22330 CHANCELLORS RUN RD UNIT A, GREAT MILLS, MD 20634-2424
(410) 800-4466
(410) 705-5024
Mailing address
4201 NORTHVIEW DR STE 104, BOWIE, MD 20716-2655
(561) 502-3978
(410) 705-5024
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20634
ZIP CODE
—
Enumeration date
05/03/2021
Last updated
05/03/2021
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